When the ER Nurse Says, “Good Luck” It’s Medical Jargon for “Next Step: The Morgue”

My daughter, Meredith (Meri) Howard overdosed on opioids last Friday. She, unlike thousands of other New Hampshire overdose victims, is alive. Meri is 24 years old, adored by the world (if not always by herself) and had been clean of opioids for more than four years. Her mom, Cindy, discovered her, called 911 and Meri was taken by ambulance to a local hospital. If Cindy hadn’t found her, this could be an obituary you’d be reading. Meri could have (would have?) died.

That ambulance ride was the last positive part of the medical response our family experienced. Really. The Hub-and-Spoke Model touted by the state at a cost of $45-million dollars, offered nothing—in fact is banned from the emergency room of the hospital she was taken to. Three or four hours after Meri arrived, our family was escorted by security off hospital property.  Apparently my manner, calm as I may appear in writing, made them very nervous indeed.

Really.

I believe I mentioned Meri had overdosed and could have died.

Please read on.

Meri was never introduced to anyone concerned about helping her get into treatment or exploring recovery.

Please.

Some problems can be solved by throwing money at them. If I’m broke and you hand me a few thousand dollars, my problem is at least temporarily solved. Most challenges, though, are a bit more complicated, requiring solutions that involve thought and planning, preferably by people who understand the challenge addressed.

Thousands of opioid overdose deaths in New Hampshire fall into that latter category. It’s not enough to simply spend money, whether directly (“Here’s a thousand dollars—please stop shooting heroin, or whatever passes for heroin on the streets”) or indirectly (“Let’s design a new model to deliver services, creating layers of bureaucracy and administrative jobs in different regions throughout the state”). Given an influx of $45,000,000 over two years, New Hampshire is well funded to address the problem, except that the solution we’ve come up with does not work now and shows no evidence of ever getting better.

I’m a man in long-term recovery, the director of Hope for New Hampshire Recovery, the chair of the Recovery Task Force and a member of the Governor’s Commission on Alcohol and Drugs. This isn’t much in terms of social standing, but it makes me more connected than, say, 99.9% of New Hampshire citizens when it comes to issues of drug and alcohol treatment and recovery. Except for one thing, the criticism of the Hub-and-Spoke model that follows might sound like the bitter words of a nonprofit leader whose funding is being cut. (Yes, money to support men and women in recovery—staying clean and sober for the rest of their lives—is being slashed despite that forty-five-million dollars. In fact, I am recommending my job be eliminated since Hope will need to do more with much less. All that, though, is for a different time and place.)

Halfway through the previous paragraph about the Hub-and-Spoke Model, I used the phrase “except for one thing” and that one thing is this: my daughter Meri almost died two days ago, was treated like a common junk bag at an emergency room and was discharged without anyone from the hospital doing a goddamned thing to get her into treatment or even connect her to the so-called Hub of the Hub-and-Spoke model. This brief essay is a jeremiad, a diatribe, a denunciation, a plea for sanity from an angry father. I speak as Meri Howard’s dad, not with any other voice.

At no point during her stay was Meri connected to the local Hub. When I asked about this, I was told Hub representatives were not allowed into the emergency room because of privacy concerns. I followed up by asking whether I could call them myself and ask someone to come and meet with Meri. They would not have been allowed into the space, regardless of Meri’s or my desires or the fact, as plain as the nose on your face, that the best time to talk with an addict about treatment and recovery might, just might, be when they’re hooked to monitors and recognize they’ve barely missed death.

Meri was treated by a nurse and doctor who demonstrated no understanding of addiction in general and opioid addiction in particular. Example? Meri’s nurse told me Meri wouldn’t need detox services because “she told me she just started using again.”

I asked the nurse if she understood that addicts or alcoholics like Meri and me lie instinctually about the frequency, amount and recency of our use. We will do anything to maintain access to our substance of choice. The nurse had no response to this, shocking for an ER nurse in the midst of what our politicians call a $45,000,000 response to an opioid epidemic. I asked the nurse for her last name, wanting to make sure she received some kind of training in addiction medicine.

“We don’t give out our last names,” she replied, and the next time she and Meri’s doctor came into the ER they stood in the 45-degree posture we’re all trained to use when confronting a potentially dangerous lunatic, a father who’s terrified for his daughter’s life or a man who’s just asked a difficult question.

Throughout the three or so hours we spent at this hospital—which I’m not naming because it could be any hospital in New Hampshire—no medical staff in my presence—and I rarely left Meri’s side—talked with her about the possibility of treatment, of getting better, of living a life free of addiction. Instead, it appeared to me that Meri was nothing more to them than her diagnosis: a drug overdose. Once that acute condition was stabilized, it was time to hit the bricks. In the vernacular, she was “treated and streeted.”

Because Meri is lucky enough to have two parents who love her dearly, her story didn’t end there. Many folks brought in with opioid overdoses have long since slashed all ties with their families, typically because of the lying, stealing and general shadiness a life addiction includes.

Because Meri is lucky enough to have her mother’s health insurance, her story didn’t end there. None of the medical providers talked about treatment, but everyone knows rehab requires money or good insurance. The Hub-and-Spoke Model was supposed to make access to treatment easier, but it’s hard to develop rapport when you’re not allowed to talk with the patient.

Because Meri is lucky enough to have a dad who was lucky enough to get sober, get back in the game and develop a network of supports, her story didn’t end there. I was able to reach out, from the minute I heard the news, to men and women throughout the state asking for guidance, asking for help, asking for prayers. Even in this chain of help, though, I ran into roadblocks, including a message from a Hub-and-Spoke Model representative: “There is certainly great room for improvement re: coordinated care across agencies!!” The person who sent that message is a kind and decent human; still, it sounded like “We certainly could use more life preservers near where your daughter is drowning.”

The prayers were answered in that Meri is now a few days into a month-long stay at a 12-Step-based treatment center in the Lakes Region. What will result from this stay will depend upon Meri, the folks she’s working with, a kind and gentle universe, and some good luck. Meri’s mom, her sisters and hundreds of other people are pulling for her, but who can tell?

She’s been lucky so far.

What about the other Meris and Matthews and Megans who OD’ed Thursday night, or today or tomorrow?  Despite an influx of serious cash, opioid users are still treated with contempt and disdain at emergency rooms. Despite the touted Hub-and-Spoke model, overdose patients still get treated and released without any connection to treatment. Despite FORTY-FIVE-MILLION DOLLARS, a huge bureaucracy, public-service announcements and, for all I know, a parade, patients brought in after overdosing are medically treated for “elevated opioid levels” rather than for addiction. Once those levels are down, I imagine the ER nurse blithely calling out, “You’re medically cleared to go. You might want to cut down on the heroin or fentanyl.  Good luck!”

“Good luck,” of course, is medical jargon for “Next step: the morgue.”

Addendum: I’ve always believed criticism should include suggestions for improvement. I’ve written elsewhere about the power of shared lived experience—as an addict and alcoholic, I can establish rapport with a person struggling with drug and alcohol issues, a connection can be created in just a few minutes of honest conversation. This may sound like mystical nitwittery, but I’ve found it true over and over and over. That rapport makes true communication possible in a manner difficult or impossible for the clinical model to replicate. Please go to my website tinywhitebox.com if you’re interested in learning more about this.

Given that connection, I call for every single emergency room in the state to have on 24-hour call men or women who’ve been addicted to opiates, have found recovery and now want  to help others. Tens of thousands of folks in recovery live in the state, and they are the vital lifeline between the sterility of the emergency room and the life of the addict. We can go the certification route, hiring only those folks who have taken the training to be CRSWs (Certified Recovery Support Workers) or we can be more daring and creative. However it is accomplished, we must provide the sick and suffering with shepherding role models who will walk them through the ER and, if the patient is willing, into treatment and recovery.

These folks don’t need to be paid a ton of money—say $15 per hour—and it’s likely turnover would be high for a while. As a man in long-term recovery (with all the other blah-blah-blahs listed above), I believe this is the only way to reach folks living in addiction.

10 thoughts on “When the ER Nurse Says, “Good Luck” It’s Medical Jargon for “Next Step: The Morgue”

  • I feel your pain and anger. I wondered if we would see real help with all this supposedly millions being shipped up from DC to alleviate the opioid crisis up here in NH. Like you say, you are 99% more connected to this than most of us, and you still have the same problems that we regular people have. Something is wrong somewhere. Please keep us informed as to what you find. I pray for your daughter along with so many others I know of. And you have every right to get mad…we should all be very angry about how its getting here and how our family members are treated. Best of luck.

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  • Thank you for sharing. This has been my advocacy for years now. See my petition at change.org DeETOX in every Hospital. It’s an epidemic but we do not treat in hospitals.

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  • Keith, the blood being squeezed out of your heart by an uncaring giant is the mental image I’m seeing. I’m glad you still have your daughter with you. You know you have a fight before you, stay strong or just fake strength until you win. Take care , Bill M.

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  • keith glad your girl is on the mend I applied to the fire department to shepard those who come in seeking help no word back yet CMC ran an ad for recovery support Melissa has creds and you have creds can you start a dialogue with them and the ceo one of my docs closed her practice to help with opiod addiction Dr Rossignal wonderful women think she is at CMC taking some classes with MPD in April network get a local channel or WMUR to allow a telethon Good luck and God speed

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  • Sorry to hear about this. It is a shame that the state has the money to do this right, yet has turned a blind eye to the power of lived experience and the peer to peer relationship as a proven way to get and keep people in recovery.

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    • I absolutely am, Shawn. Still, I worry about the dozens and dozens of other folks in the state who have overdosed in the past month, but who have not found their ways into recovery. Thanks for writing.

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  • Would a death by opioid overdose be categorized on a death certification as “natural, accident, suicide, homicide or undetermined?” It’s interesting that if the death certification is done correctly and applied to each individual circumstance it could be any of these. Family members should check that the death certificate in their decedent’s case is accurate because over the whole spectrum, this data will go far to figure out what’s actually going on.

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